BackMarketplace
Leaf & Leaf Premier Plans
Marketplace plans are for individuals and family members under the age of 65. Marketplace Leaf plans cover the essential health benefits you need to feel secure. Marketplace Leaf Premier plans provide the same health benefits as Marketplace Leaf plans, plus adult vision and dental care.
Plan Highlights:
- No-cost annual checkups
- Preventive and wellness visits
- Hospital, emergency room, and urgent care visits
- Lab tests and X-rays
- Prescription drug coverage
- Maternity and newborn coverage
- Optional dental and vision coverage
- 24/7 access to care with telemedicine (Teladoc)*
- Physical, occupational, and speech therapy
- Annual gym membership reimbursement**
- 2024
- 2023
Tier
Platinum Leaf
Platinum Leaf Premier
Summary of Benefits and Coverage (PDF)
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island and Westchester
Dental Care
Pediatric – $15 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Vision Exams
Pediatric – $15 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Deductible (Individual)
$0
$0
Maximum Out-of-Pocket (Individual)
$2,000
$2,000
Deductible (Family)
$0
$0
Maximum Out-of-Pocket (Family)
$4,000
$4,000
Your Annual Checkup
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$15 copay
$10 copay
Specialist Visit
$35 copay
$40 copay
Retail Health Clinic
$15 copay
$10 copay
Urgent Care
$55 copay
$55 copay
Emergency Room
$100 copay
$100 copay
Ambulance
$100 copay
$100 copay
Surgeon
$100 copay
$100 copay
Outpatient Facility
$100 copay
$100 copay
Inpatient Hospital Stay
$500 copay per admission
$500 copay per admission
- Preventive Pediatric GuideEnglish
- Women’s Preventive Services
- Full List of Approved Preventive Services
Prescriptions
Generic Drugs (Tier 1)
$10 copay
$5 copay
Brand Name Preferred (Tier 2)
$30 copay
$50 copay
Brand Name Non-Preferred (Tier 3)
$60 copay
$85 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$25 copay
$10 copay
Covered Prescription Drugs (Formulary)
English
Tier
Gold Leaf
Gold Leaf Premier
Gold Leaf Premier Plus
Summary of Benefits and Coverage (PDF)
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island and Westchester
Dental Care
Pediatric – $25 copay after deductible
Adult – not covered
Pediatric – $20 copay
Adult – $20 copay
Pediatric – $20 copay
Adult – $20 copay
Vision Exams
Pediatric – $25 copay after deductible
Adult – not covered
Pediatric – $20 copay after deductible
Adult – $20 copay after deductible
Pediatric – $20 copay after deductible
Adult – $20 copay after deductible
Telemedicine (Teladoc)
$0 copay
$0 copay
$0 copay
Costs & Benefits
Deductible (Individual)
$600
$1000
$750
Maximum Out-of-Pocket (Individual)
$4,750
$6,250
$6,000
Deductible (Family)
$1,200
$2,000
$1,500
Maximum Out-of-Pocket (Family)
$9,500
$12,500
$12,000
Your Annual Checkup
$0 copay
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$25 copay after deductible
$20 copay not subject to deductible
$20 copay not subject to deductible for 1st visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second opinion visit)
$20 copay after deductible for additional visits
Specialist Visit
$40 copay after deductible
$40 copay after deductible
$40 copay not subject to deductible for 1st visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second opinion visit)
$40 copay after deductible for additional visits
Retail Health Clinic
$25 copay after deductible
$20 copay not subject to deductible
$20 copay not subject to deductible
Urgent Care
$60 copay after deductible
$60 copay after deductible
$60 copay after deductible
Emergency Room
$150 copay after deductible
$175 copay after deductible
$250 copay after deductible
Ambulance
$150 copay after deductible
$150 copay after deductible
$150 copay after deductible
Surgeon
$100 copay after deductible
$100 copay after deductible
$100 copay after deductible
Outpatient Facility
$100 copay after deductible
$100 copay after deductible
$100 copay after deductible
Inpatient Hospital Stay
$1,000 copay per admission
$1,000 copay per admission
$1,000 copay per admission
- Preventive Pediatric GuideEnglish
- Women’s Preventive Services
- Full List of Approved Preventive Services
Prescriptions
Generic Drugs (Tier 1)
$10 copay
$7 copay
$7 copay
Brand Name Preferred (Tier 2)
$35 copay
$50 copay
$50 copay
Brand Name Non-Preferred (Tier 3)
$70 copay
$100 copay
$100 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$25 copay
$14 copay
$14 copay
Covered Prescription Drugs (Formulary)
English
Prices vary based on income, please select view.
View current Federal Poverty Guidelines (PDF) to see where you fall. Or Get a Quote
Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Summary of Benefits and Coverage (PDF)
Premium
Monthly premium costs depend on household income and size
Eligible Age
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island and Westchester
Dental Care
Vision Exams
Telemedicine (Teladoc)
Costs & Benefits
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Deductible (Individual)
Maximum Out-of-Pocket (Individual)
Deductible (Family)
Maximum Out-of-Pocket (Family)
Your Annual Checkup
Primary Care Provider (PCP) Visit
Specialist Visit
Retail Health Clinic
Urgent Care
Emergency Room
Ambulance
Surgeon
Outpatient Facility
Inpatient Hospital Stay
- Preventive Pediatric GuideEnglish
- Women’s Preventive Services
- Full List of Approved Preventive Services
Prescriptions
Generic Drugs (Tier 1)
Brand Name Preferred (Tier 2)
Brand Name Non-Preferred (Tier 3)
90-Day Mail-Order Supply for Generic (Tier 1)
Covered Prescription Drugs (Formulary)
English
Tier
Bronze Leaf
Bronze Leaf Premier
Summary of Benefits and Coverage (PDF)
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island and Westchester
Dental Care
Pediatric – $50 copay after deductible
Adult – not covered
Pediatric – $50 copay after deductible
Adult - $50 copay after deductible
Vision Exams
Pediatric – $50 copay after deductible
Adult – not covered
Pediatric – $50 copay after deductible
Adult - $50 copay after deductible
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Deductible (Individual)
$4,700
$5,250
Maximum Out-of-Pocket (Individual)
$8,700
$8,700
Deductible (Family)
$9,400
$10,500
Maximum Out-of-Pocket (Family)
$17,400
$17,400
Your Annual Checkup
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$50 copay not subject to deductible for first 3 visits (any combination of PCP, specialist or outpatient mental health/substance use disorder)
$50 copay after deductible for additional visits
$50 copay not subject to deductible
Specialist Visit
$75 copay not subject to deductible for first 3 visits (any combination of PCP, specialist or outpatient mental health/substance use disorder)
$75 copay after deductible for additional visits
$75 copay after deductible
Retail Health Clinic
$50 copay after deductible
$50 copay not subject to deductible
Urgent Care
$75 copay after deductible
$75 copay after deductible
Emergency Room
$500 copay after deductible
$500 copay after deductible
Ambulance
$300 copay after deductible
$300 copay after deductible
Surgeon
$150 copay after deductible
$150 copay after deductible
Outpatient Facility
$150 copay after deductible
$150 copay after deductible
Inpatient Hospital Stay
$1,500 copay per admission after deductible
$1,500 copay per admission after deductible
- Preventive Pediatric GuideEnglish
- Women’s Preventive Services
- Full List of Approved Preventive Services
Prescriptions
Generic Drugs (Tier 1)
$10 copay after deductible
$10 copay after deductible
Brand Name Preferred (Tier 2)
$35 copay after deductible
$35 copay after deductible
Brand Name Non-Preferred (Tier 3)
$70 copay after deductible
$70 copay after deductible
90-Day Mail-Order Supply for Generic (Tier 1)
$25 copay after deductible
$20 copay after deductible
Covered Prescription Drugs (Formulary)
English
Tier
Green Leaf
Premium
Monthly premium costs depend on household income and size
Eligible Age
Individuals Under 30
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island and Westchester
Dental Care
$0 copay after deductible; Pediatrics Only - for members up to Age 19
Vision Exams
$0 copay after deductible; Pediatrics Only - for members up to Age 19
Telemedicine (Teladoc)
$0 copay
Costs & Benefits
Green Leaf
Deductible (Individual)
$9,100
Maximum Out-of-Pocket (Individual)
$9,100
Deductible (Family)
$18,200
Maximum Out-of-Pocket (Family)
$18,200
Your Annual Checkup
$0 copay
Primary Care Provider (PCP) Visit
$0 copay for first 3 visits (any combination of PCP, specialist, or outpatient mental health/substance use disorder)
$0 copay after deductible for additional visits
Specialist Visit
$0 copay after deductible
Retail Health Clinic
$0 copay after deductible
Urgent Care
$0 copay after deductible
Emergency Room
$0 copay after deductible
Ambulance
$0 copay after deductible
Surgeon
$0 copay after deductible
Outpatient Facility
$0 copay after deductible
Inpatient Hospital Stay
$0 copay after deductible
- Preventive Pediatric GuideEnglish
- Women’s Preventive Services
- Full List of Approved Preventive Services
Prescriptions
Generic Drugs (Tier 1)
$0 copay after deductible
Brand Name Preferred (Tier 2)
$0 copay after deductible
Brand Name Non-Preferred (Tier 3)
$0 copay after deductible
90-Day Mail-Order Supply for Generic (Tier 1)
$0 copay after deductible
Covered Prescription Drugs (Formulary)
English
Tier
Platinum Leaf
Platinum Leaf Premier
Summary of Benefits and Coverage (PDF)
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Dental Care
Pediatric – $15 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Vision Exams
Pediatric – $15 copay
Adult – not covered
Pediatric – $10 copay
Adult – $10 copay
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Deductible (Individual)
$0
$0
Maximum Out-of-Pocket (Individual)
$2,000
$2,000
Deductible (Family)
$0
$0
Maximum Out-of-Pocket (Family)
$4,000
$4,000
Your Annual Checkup
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$15 copay
$10 copay
Specialist Visit
$35 copay
$40 copay
Retail Health Clinic
$15 copay
$10 copay
Urgent Care
$55 copay
$55 copay
Emergency Room
$100 copay
$100 copay
Ambulance
$100 copay
$100 copay
Surgeon
$100 copay
$100 copay
Outpatient Facility
$100 copay
$100 copay
Inpatient Hospital Stay
$500 copay per admission
$500 copay per admission
- Preventive Pediatric GuideEnglish
- Women’s Preventive Services
- Full List of Approved Preventive Services
Prescriptions
Generic Drugs (Tier 1)
$10 copay
$5 copay
Brand Name Preferred (Tier 2)
$30 copay
$50 copay
Brand Name Non-Preferred (Tier 3)
$60 copay
$85 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$25 copay
$10 copay
Covered Prescription Drugs (Formulary)
English
Tier
Gold Leaf
Gold Leaf Premier
Gold Leaf Premier Plus
Summary of Benefits and Coverage (PDF)
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Dental Care
Pediatric – $25 copay after deductible
Adult – not covered
Pediatric – $20 copay
Adult – $20 copay
Pediatric – $25 copay
Adult – $25 copay
Vision Exams
Pediatric – $25 copay after deductible
Adult – not covered
Pediatric – $20 copay after deductible
Adult – $20 copay after deductible
Pediatric – $25 copay after deductible
Adult – $25 copay after deductible
Telemedicine (Teladoc)
$0 copay
$0 copay
$0 copay
Costs & Benefits
Deductible (Individual)
$600
$1,050
$750
Maximum Out-of-Pocket (Individual)
$5,900
$6,500
$6,000
Deductible (Family)
$1,200
$2,100
$1,500
Maximum Out-of-Pocket (Family)
$11,800
$13,000
$12,000
Your Annual Checkup
$0 copay
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$25 copay after deductible
$20 copay not subject to deductible
$25 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$25 copay after deductible for additional visits
Specialist Visit
$40 copay after deductible
$40 copay after deductible
$40 copay not subject to deductible for first visit (PCP, specialist, outpatient mental health/substance use disorder, chiropractor, allergy, Applied Behavioral Analysis (ABA), or second-opinion visit)
$40 copay after deductible for additional visits
Retail Health Clinic
$25 copay after deductible
$20 copay not subject to deductible
$25 copay not subject to deductible
Urgent Care
$60 copay after deductible
$60 copay after deductible
$60 copay after deductible
Emergency Room
$150 copay after deductible
$175 copay after deductible
$250 copay after deductible
Ambulance
$150 copay after deductible
$150 copay after deductible
$150 copay after deductible
Surgeon
$100 copay after deductible
$100 copay after deductible
$100 copay after deductible
Outpatient Facility
$100 copay after deductible
$100 copay after deductible
$100 copay after deductible
Inpatient Hospital Stay
$1,000 copay per admission
$1,000 copay per admission
$1,000 copay per admission
- Preventive Pediatric GuideEnglish
- Women’s Preventive Services
- Full List of Approved Preventive Services
Prescriptions
Generic Drugs (Tier 1)
$10 copay
$7 copay
$10 copay
Brand Name Preferred (Tier 2)
$35 copay
$50 copay
$50 copay
Brand Name Non-Preferred (Tier 3)
$70 copay
$100 copay
$100 copay
90-Day Mail-Order Supply for Generic (Tier 1)
$25 copay
$14 copay
$20 copay
Covered Prescription Drugs (Formulary)
English
Prices vary based on income, please select view.
View current Federal Poverty Guidelines (PDF) to see where you fall. Or Get a Quote
Tier
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Summary of Benefits and Coverage (PDF)
Premium
Monthly premium costs depend on household income and size
Eligible Age
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Dental Care
Vision Exams
Telemedicine (Teladoc)
Costs & Benefits
Silver Leaf
Silver Leaf Premier
Silver Leaf Premier Plus
Deductible (Individual)
Maximum Out-of-Pocket (Individual)
Deductible (Family)
Maximum Out-of-Pocket (Family)
Your Annual Checkup
Primary Care Provider (PCP) Visit
Specialist Visit
Retail Health Clinic
Urgent Care
Emergency Room
Ambulance
Surgeon
Outpatient Facility
Inpatient Hospital Stay
- Preventive Pediatric GuideEnglish
- Women’s Preventive Services
- Full List of Approved Preventive Services
Prescriptions
Generic Drugs (Tier 1)
Brand Name Preferred (Tier 2)
Brand Name Non-Preferred (Tier 3)
90-Day Mail-Order Supply for Generic (Tier 1)
Covered Prescription Drugs (Formulary)
English
Tier
Bronze Leaf
Bronze Leaf Premier
Summary of Benefits and Coverage (PDF)
Premium
Monthly premium costs depend on household income and size
Eligible Age
Under 65
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Dental Care
Pediatric – $50 copay after deductible
Adult – not covered
Pediatric – $50 copay after deductible
Adult - $50 copay after deductible
Vision Exams
Pediatric – $50 copay after deductible
Adult – not covered
Pediatric – $50 copay after deductible
Adult - $50 copay after deductible
Telemedicine (Teladoc)
$0 copay
$0 copay
Costs & Benefits
Deductible (Individual)
$4,600
$6,000
Maximum Out-of-Pocket (Individual)
$9,450
$8,700
Deductible (Family)
$9,200
$12,000
Maximum Out-of-Pocket (Family)
$18,900
$17,400
Your Annual Checkup
$0 copay
$0 copay
Primary Care Provider (PCP) Visit
$50 copay not subject to deductible for first three visits (any combination of PCP, specialist, or outpatient mental health/substance use disorder)
$50 copay after deductible for additional visits
$50 copay not subject to deductible
Specialist Visit
$75 copay not subject to deductible for first three visits (any combination of PCP, specialist, or outpatient mental health/substance use disorder)
$75 copay after deductible for additional visits
$75 copay after deductible
Retail Health Clinic
$50 copay after deductible
$50 copay not subject to deductible
Urgent Care
$75 copay after deductible
$75 copay after deductible
Emergency Room
$500 copay after deductible
$500 copay after deductible
Ambulance
$300 copay after deductible
$300 copay after deductible
Surgeon
$150 copay after deductible
$150 copay after deductible
Outpatient Facility
$150 copay after deductible
$150 copay after deductible
Inpatient Hospital Stay
$1,500 copay per admission after deductible
$1,500 copay per admission after deductible
- Preventive Pediatric GuideEnglish
- Women’s Preventive Services
- Full List of Approved Preventive Services
Prescriptions
Generic Drugs (Tier 1)
$10 copay after deductible
$10 copay after deductible
Brand Name Preferred (Tier 2)
$35 copay after deductible
$35 copay after deductible
Brand Name Non-Preferred (Tier 3)
$70 copay after deductible
$70 copay after deductible
90-Day Mail-Order Supply for Generic (Tier 1)
$25 copay after deductible
$20 copay after deductible
Covered Prescription Drugs (Formulary)
English
Tier
Green Leaf
Premium
Monthly premium costs depend on household income and size
Eligible Age
Individuals Under 30
Eligible Service Areas
Within New York City’s five boroughs (the Bronx, Brooklyn, Manhattan, Queens, and Staten Island), Long Island, and Westchester.
Dental Care
$0 copay after deductible; pediatrics only - for members up to Age 19
Vision Exams
$0 copay after deductible; pediatrics only - for members up to Age 19
Telemedicine (Teladoc)
$0 copay
Costs & Benefits
Green Leaf
Deductible (Individual)
$9,450
Maximum Out-of-Pocket (Individual)
$9,450
Deductible (Family)
$18,900
Maximum Out-of-Pocket (Family)
$18,900
Your Annual Checkup
$0 copay
Primary Care Provider (PCP) Visit
$0 copay for first three (3) visits (any combination of PCP, specialist, or outpatient mental health/substance use disorder)
$0 coinsurance after deductible for additional visits
Specialist Visit
$0 copay after deductible
Retail Health Clinic
$0 copay after deductible
Urgent Care
0% coinsurance after deductible
Emergency Room
0% coinsurance after deductible
Ambulance
0% coinsurance after deductible
Surgeon
0% coinsurance after deductible
Outpatient Facility
0% coinsurance after deductible
Inpatient Hospital Stay
0% coinsurance after deductible
- Preventive Pediatric GuideEnglish
- Women’s Preventive Services
- Full List of Approved Preventive Services
Prescriptions
Generic Drugs (Tier 1)
0% coinsurance after deductible
Brand Name Preferred (Tier 2)
0% coinsurance after deductible
Brand Name Non-Preferred (Tier 3)
0% coinsurance after deductible
90-Day Mail-Order Supply for Generic (Tier 1)
0% coinsurance after deductible
Covered Prescription Drugs (Formulary)
English
**Up to $400 during coverage year; up to an additional $200 during coverage year for spouse.
The benefit information provided is a brief summary, not a complete description, of benefits. For more information, contact the plan.
Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”). Plans contain exclusions and limitations.
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Additional Benefits
-
24/7 Access to Telemedicine with Teladoc*
Talk to a doctor any time—for a $0 copay. Visit with board-certified doctors through video chat or phone for prescriptions, treatment of non-emergency health issues, and more. Access to dermatologists is also available.
*Telemedicine isn’t a replacement for your primary care provider (PCP). Your PCP should always be your first choice for care (both in-person and virtual visits).
-
Active&Fit Direct
Healthfirst makes working out affordable, too! For just $28/month, you get a standard membership to a fitness center in your area. Premium fitness center options are available for an additional fee. Track your activity, monitor your progress, achieve your fitness goals, and so much more! Visit activeandfitdirect.com to learn more.
-
ExerciseRewards™ Program
Physical activity is one of the simplest ways to stay healthy, and Healthfirst makes it even more rewarding! With the Active&Fit ExerciseRewards™ program, you can earn $200 every six months if you visit a qualifying fitness center at least 50 days during the same six-month reward period. Contact ExerciseRewards at 1-877-810-2746 to learn more about qualifying fitness centers.
Additional Benefits
-
24/7 Access to Telemedicine with Teladoc*
-
Active&Fit Direct
-
ExerciseRewards™ Program
Frequently Asked
Questions
See All
-
What are NY Marketplace plans?
-
How do I qualify for a Marketplace insurance plan?
-
Can I get help paying for health coverage?
Support When You Need It
We’re happy to answer your questions.
Learn about enrollment
1-844-488-1486
Monday to Saturday, 8am–8pm
TTY English: 1-888-542-3821
TTY Español: 1-888-867-4132
Member Services
1-888-250-2220
Monday to Saturday, 8am–8pm
TTY English: 1-888-542-3821
TTY Español: 1-888-867-4132
Can’t talk right now?
Request a callback and we’ll get back to you within one business day.
You can also visit our Virtual Community Office to connect with a local Healthfirst representative or to find a community office near you.
You can also go to the NY State of Health’s website to view your choices, or call the NY State of Health customer service center at 1-855-355-5777.
We look forward to helping you!
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